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An eighth note.

Meng-Rong Tsai1, Chiu-Yang Lee1,2, Chih-Yu Yang1,3,4,5,6

  • 1Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei.

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|August 19, 2021
PubMed
Summary
This summary is machine-generated.

A rare "eighth note" sign in arteriovenous fistula (AVF) stenosis, often causing hemodialysis access failure, was observed. This unique collateral vein formation resolved after angioplasty, highlighting key conditions for its appearance.

Keywords:
arteriovenous fistulacollateral circulationhemodialysisregional blood flowvascular patency

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Area of Science:

  • Vascular Surgery
  • Nephrology
  • Interventional Radiology

Background:

  • Venous stenosis is the primary cause of arteriovenous fistula (AVF) failure in patients undergoing hemodialysis.
  • Stenosis in AVFs can lead to increased pressure proximal to the lesion, especially with adequate arterial inflow.
  • Juxta-anastomotic stenosis is a common site for AVF complications.

Purpose of the Study:

  • To report a unique angiographic finding in a patient with juxta-anastomotic AVF stenosis.
  • To describe the characteristics and resolution of a collateral venous branch resembling an "eighth note" sign.
  • To postulate the specific conditions required for the formation of this rare sign in radiocephalic fistulas.

Main Methods:

  • Case report of a chronic hemodialysis patient.
  • Angiographic examination to evaluate juxta-anastomotic stenosis of the AVF.
  • Percutaneous transluminal angioplasty (PTA) performed for the stenotic lesion.

Main Results:

  • A unique collateral venous branch, termed the "eighth note" sign, was identified antecedent to the stenotic lesion.
  • The "eighth note" sign showed marked attenuation immediately following successful PTA.
  • This sign is infrequently observed, suggesting specific etiological factors.

Conclusions:

  • The "eighth note" sign in radiocephalic fistulas is a rare finding associated with juxta-anastomotic stenosis.
  • Its formation likely requires sufficient arterial inflow, a closely situated collateral branch, severe stenosis, and intact ulnar venous drainage.
  • Angioplasty effectively resolves this specific collateral venous manifestation.